A package of pills sent to patients in a study on medical abortions, which is being conducted in four states. (Courtesy of the University of Hawaii)

By Phil Galewitz
Kaiser Health News

When the abortion pills arrived in her mailbox this summer, she felt anxious but also in control, knowing she could end her pregnancy entirely in the privacy of her own home.

“I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me,” she said, asking to be identified only by her middle name, Marie, because she did not want people outside her immediate family to know about her abortion.

Marie is part of a small but closely watched research effort to determine whether medical abortions — those induced by medicine instead of surgery — can be done safely through an online consultation with a doctor and drugs mailed to a woman’s home.

At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women. Opponents of abortion find the concept dangerous and deeply disturbing. [Read more…]

For years, available contraception methods have generally made this a woman’s responsibility.

But researchers report they may be getting closer to changing the calculation, according to findings published last week in the Journal of Clinical Endocrinology and Metabolism. They offered evidence that a new hormonal injection can stop men from producing sperm.

The problem: Three years in, the researchers agreed to terminate the study early, citing potential side effects. That revelation is drawing some criticism. [Read more…]

During her residency in obstetrics and gynecology at the University of Pittsburgh Medical Center in 2012, Michelle Moniz treated an expectant mother in her early 20s who wanted an intrauterine birth control device surgically inserted immediately after her delivery.

But because the state Medicaid agency didn’t use a separate billing code for the device, commonly known as an IUD, the hospital couldn’t accommodate the woman’s wishes. She would have to wait until her six-week, post-partum checkup to have the procedure to prevent unwanted pregnancies.

The woman didn’t show for that appointment. But it was not the last time Moniz saw her. A few months later the woman showed up pregnant again — and not by design.

Moniz, now a clinician and birth control researcher at the University of Michigan Medical School, said she and colleagues have seen many similar instances in which poor pregnant women on Medicaid wanted long-lasting contraception — IUDs or other birth control implants — immediately after delivery, only to be turned away because Medicaid billing procedures didn’t accommodate them. [Read more…]

It’s that time of year. The kids have been in school for a while and the germs are circulating. We sat down with Libby Page from our Immunizations Program to learn what our options are for flu vaccine this season.

Why is it important to get vaccinated now?

LP: Autumn is often the time when flu activity picks up and it can take at least two weeks from the date of vaccination for most people to generate vaccine induced immunity.

Also, children aged 6 months through 8 years who have not been vaccinated in previous years will need two doses of flu vaccine.

To provide the best protection, it’s important that they get their first dose as soon as possible and get their second dose at least 4 weeks later.

We are so excited for our expecting co-workers! We get the flu shot to protect them and their babies from the spread of flu!

When is it too late to get my flu shot?

While early vaccination is most effective, the CDC also advises that vaccination should continue as long as flu viruses are circulating because the duration of the flu season can vary.

For example, if you get a flu shot in December or later, you could still be protected for the remainder of the flu season, which can last well into the spring. [Read more…]

A number of states recently have dedicated more money to educating women and health care providers about the 99 percent effectiveness of long-acting, reversible forms of contraception, like the intrauterine device, or IUD — shown here.

Nurse practitioner Kim Hamm talked in soothing tones to her 14-year-old patient as she inserted a form of long-acting contraception beneath the skin of the girl’s upper arm.

“This is the numbing medicine, so you’re going to feel me touch you here,” she said, taking the teen’s arm. “Little stick, one, two three, ouch. And then a little bit of burn.”

Hamm works at the Gaston County Teen Wellness Center, in Gastonia, N.C., which provides counseling, education and medical care. The teenager had already talked through her birth control options with another health care provider and chosen the implant — a flexible rod, about the size of a matchstick, that slowly releases low levels of hormones to prevent pregnancy.

“You’re going to feel tons of pressure here,” Hamm says, using a small device to insert the implant. “That’s it!”

And, in terms of preventing pregnancy, that will be it for the teen for the next several years. [Read more…]

AUSTIN — Peggy Wall, a family nurse practitioner at a local community health center, treats many women in their 40s, who already have a family and find themselves confronting an accidental pregnancy.

Many, she says, wish they had taken preventive steps after their last child was born and could be good candidates for getting an intrauterine device in the delivery room, immediately after giving birth. Until recently, that sort of IUD access has been difficult to come by.

“Some of them have chaotic lives — or they think they won’t be insured,” she said. “We try to help them.”

Soon, she said, that should become easier.

Health officials are trying to rebuild the state’s women’s health program, a complicated project launched after Texas in 2011 cut funds for family planning that had been going to Planned Parenthood and other clinics affiliated — even loosely — with abortion providers.

As part of the new program, the state is trying to bolster low-income women’s access to birth control to curb unintended pregnancies.

Nationally, about half of pregnancies are unintended. And Texas is one of nearly two dozen states changing their Medicaid programs, the federal-state insurance plan for low-income people, to pay hospitals for inserting an IUD or contraceptive implant in the delivery room.

In the past, most Medicaid program generally offered a set payment for labor and delivery and didn’t include an option for payment for the IUD insertion.

Houston-based Legacy Community Health Services, a federally qualified health center, is trying hard to fight the Zika virus. It’s screening pregnant women and following federal guidelines to test people at risk.

But despite best efforts, there’s a problem, says Legacy’s chief medical officer, Dr. Ann Barnes. Women who could be infected usually have to wait as long as a month to know if their pregnancy is at risk. That’s the turnaround time from the state public health lab, where blood samples are sent for testing.

“In that situation, the anxiety a pregnant woman has to live with is great,” Barnes said. “Ideally, we’d be able to speed up the process.”

It’s not just an issue in Houston. In areas where Zika poses a threat, public health departments are struggling to meet the need to test patients for the mosquito-borne virus, even for those the government has classified as “at risk.”

Doctors and health experts say last month’s approval of $1.1 billion in emergency funding by Congress — a spending package to fight the virus — could help, giving local labs the resources to efficiently determine if people have been infected. [Read more…]

HUNTINGTON, W.Va. — Before hospitals in the rest of the country started seeing a surge in the number of infants born with severe drug withdrawal symptoms, this town of 50,000 was already facing a crisis.

In 2010, babies born to mothers using heroin were filling up so many beds in the newborn intensive care unit at the city’s main hospital that little space was left for babies with other life-threatening conditions.

The nurses who cared for these agitated and often inconsolable infants knew there was a better and less costly way to help newborns through the painful, weekslong process of drug withdrawal.

By 2012, they had created a separate newborn therapy unit just for babies in withdrawal. Because their treatment didn’t require the same high-tech equipment needed in an intensive care unit, it was about half the cost of neonatal intensive care, according to Dr. Sean Loudin, who heads the new unit at Cabell Huntington Hospital.

The next step was to create an infant recovery center outside the hospital where newborns could be taken as soon as it was safe to leave the hospital, usually within two weeks. Not only would it free up beds for other newborns who need intensive care, it would be tailored to the needs of infants in drug withdrawal, and their parents. [Read more…]

Although the United States recently experienced a slight drop in maternal deaths, the nation’s maternal mortality rate has risen steeply since 2000 at the same time it fell by more than a third globally.

New data from the University of Washington’s Institute of Health Metrics and Evaluation, a research group funded by the Gates Foundation, indicates that between 2000 and 2015, the maternal mortality rate in the U.S. increased by nearly 47 percent, from 17.1 deaths per 100,000 population to 25.1 deaths.

The 2015 figure, however, represents a drop since 2013, when the institute recorded 27.8 deaths per 100,000.

The 15-year trend in the U.S. not only runs counter to the worldwide rate, but to that in most other industrialized countries. The 2015 rate of maternal deaths in the U.S. also remains higher than that in many industrialized countries. For example, the institute reported 6.9 deaths per 100,000 in Canada, 7.6 in France, and 6.3 in Japan. [Read more…]

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